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Volume 4 No 50; 17 December 2010

Seasonal flu levels increasing in the UK

Influenza activity is increasing and levels of consultation for influenza like illness in primary care have now exceeded base line thresholds in England. The rise in the number of reported cases in the community has been accompanied by reports of patients with serious illness requiring hospitalisation and numerous outbreaks of flu in schools across the country. The HPA Weekly National Influenza Report [1] provides a regular situation report on flu and flu-like illness in the UK.

The headline influenza indicators reported in the 16 December edition [2] are:
  • in week 49 (ending 12 December), the weekly influenza/influenza-like illness (ILI) consultation rate increased to above baseline levels in England (34.6 per 100,000);
  • reports of severe illness due to influenza infection including ICU/ECMO (intensive care unit/extra-corporeal membrane oxygenation) admissions and the number of influenza-associated deaths increased in the last few weeks (since week 36, 17 deaths associated with influenza infection have been reported);
  • influenza A H1N1 (2009) and B are the predominant circulating viruses. The virus strains circulating are well matched to the current influenza vaccine and very little antiviral resistance has been detected;
  • fifty-seven acute respiratory disease outbreaks were reported in the UK in week 49, 55 schools, one care home and one hospital;
  • eighty-four of 149 (56.4%) specimens from patients with ILI presenting to sentinel GPs in England in week 49, were reported as positive for influenza.

Following the increase in the level of seasonal influenza circulating in the UK reported last week, the Department of Health issued guidance on the use of antiviral drugs for the management of those influenza patients in England who are at high risk of developing complications from flu [3]. The Department is also encouraging those in at-risk groups to be vaccinated and has written to PCTs/SHAs suggesting that GP practices should actively invite those in at-risk groups to visit surgeries to be vaccinated [4]. The Chief Medical Officer has also issued an update on appropriate guidelines for the treatment and management of patients with influenza in secondary care and other settings [5]. Updated guidance on the pharmacological treatment and prophylaxis of influenza has just been published on the HPA website [6]. The HPA has reiterated that, although not life-threatening for most people, seasonal flu can be far more dangerous for those in "at-risk" groups: people aged 65 and over, and people aged under 65 in clinical risk groups which includes all pregnant women.

References

1. The HPA Weekly National Influenza Report is published weekly (Thursday afternoons) throughout the flu season presenting information relating to flu and flu-like illness reports. Available from the HPA website at: Home > Topics > Infectious Diseases > Infections A-Z > Seasonal Influenza > Epidemiological Data > HPA National Influenza Report.

2. http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287146386672.

3. DH, 10 December, 2010. Letter from the Director of Immunisation stating that, in line with the National Institute of Clinical Excellence (NICE) guidance, the use of antiviral drugs for the prevention or treatment of influenza is now recommended: www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_122572.

4. DH, 15 December, 2010. Letter from the Director of Immunisation to SHA immunisation leads encouraging them to increase uptake of the seasonal flu vaccination, especially in low-uptake areas: www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_122722.

5. DH, 14 December, 2010. Letter from the CMO on appropriate guidelines for the treatment and management of patients with influenza in secondary care and other settings. www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_122682.

6. HPA. Pharmacological treatment and prophylaxis of influenza. Available at: Home > Topics > Infectious Diseases > Infections A-Z > Seasonal Influenza > Information for health professionals.

British Standard on legionella risk assessments

The British Standards Institution has published a new standard on the assessment of risk of contamination of building water systems by legionella bacteria, providing guidance, for those directly or indirectly involved in their management, on how to comply with the legal risk assessment requirement and therefore, indirectly, to comply with the broader requirements of health safety legislation.

BS 8580:2010. Water quality - risk assessments for legionella control - code of practice [1], supplements the existing British Standard on sampling (BS 7592 Sampling for legionella bacteria in water systems) and the Health and Safety Executive Approved Code of Practice, known as L8 [2], that describes the statutory duties - including for risk assessment - arising out of the Management of Health and Safety at Work Regulations and the Control of Substances Hazardous to Health Regulations [2].

The standard is intended both for those preparing and using risk assessments, but particularly for building occupiers, facilities managers and specialist consultants.

The formal recommendations ("normative references") comprising the core sections of the standard cover the main water system categories (ie cooling towers, spas, and conventional hot-and-cold water systems) and the factors to be considered in the risk assessment (ie preparations for the risk assessment; desktop appraisal of documentation; site visits/survey; risk assessment reporting; and risk review).

Illustrative ("informative") appendices to the main standard provide further guidance: both generally about the chain of events that create a public health hazard (ie system "contamination" and "amplification" and "dispersal/transmission" of contaminated aerosols that may cause legionnaires disease) and on assessing risk related to specific types of water system (fire suppression systems; fountains and water systems; humidifiers; vehicle wash systems; solar heating systems; etc).

The British Standard concerns identification and assessment of sources of risk and applies both to assessments being carried out for the first time and to reviews or audits of assessments previously carried out. It applies only to risks presented by artificial water systems (not natural waters). It does not encompass the other responsibilities of duty holders (ie occupiers of premises, operators of "risk systems", etc) - to prevent or control risk, prepare a "scheme of control" and to implement, manage and monitor precautions, keep records of precautions, etc - that are covered in general terms in HSE ACP L8 and other official guidance documents.

Legionnaires' disease is a severe pneumonia with a relatively high fatality rate; it is caused by the inhalation of some species of Legionella spp bacterium that are found in the natural environment but become an occupational and public health hazard when they colonise artificial water systems. Because there is no person-to-person transmission of the infection, identification of contaminated water systems is necessary to contain outbreaks and implementation of the precautions outlined in the new standard is necessary for public health protection in general.

References

1. BS 8580: 2010, Water quality - risk assessments for legionella control - code of practice, December 2010, available in PDF and hard copy format, £162.00 (£81.00, BSI members). Downloadable from BSI website at: http://shop.bsigroup.com/en/ProductDetail/?pid=000000000030200235.

2. Health and Safety Executive (2000). Legionnaires' disease - the control of l egionella bacteria in water systems. Approved Code of Practice and guidance L8 (third edition). Available at: http://www.hse.gov.uk/pubns/priced/l8.pdf.